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Does COVID-19 Confer Risk for Venous Thromboembolism in Ambulatory Patients?
Evidence is mixed about risk for venous thromboembolism (VTE) among patients with ambulatory SARS-CoV-2 infections (NEJM JW Gen Med May 1 2021 and JAMA Intern Med 2021; 181:997; NEJM JW Gen Med Jun 1 2022 and BMJ 2022; 377:e069590). In this U.K. population-based cohort study, researchers determined the 30-day risk for VTE (i.e., deep venous thrombosis or pulmonary embolism) among 19,000 outpatients (mean age, 64) with ambulatory COVID-19.
SARS-CoV-2–positive patients had significantly higher risk for VTE within 30 days than did matched controls (incidence rate, 51 vs. 2 per 1000 person-years; hazard ratio, 21). Excess risk was higher for unvaccinated people (HR, 28) than for vaccinated people (HR, 6). Among patients with SARS-CoV-2 infections, older age, male sex, obesity, inherited thrombophilia, and no or partial vaccination were independent risk factors for VTE.
Comment
Although residual confounding is possible, ambulatory COVID-19 was associated with markedly elevated risk for VTE — particularly in unvaccinated people. These results obviously reinforce the value of vaccination. Whether thromboprophylaxis also would be beneficial in ambulatory patients, as it is in hospitalized COVID-19 patients (NEJM JW Gen Med Dec 15 2021 and BMJ 2021 375:n2400), remains unclear. In a small randomized trial, enoxaparin thromboprophylaxis did not reduce risk for hospitalization and death; however, the trial was underpowered to demonstrate superiority regarding reduction in VTE risk (NEJM JW Oncol Hematol Sep 2022 and Lancet Haematol 2022; 8:E585).
Citation(s)
Author:
Xie J et al.
Title:
Clinical and genetic risk factors for acute incident venous thromboembolism in ambulatory patients with COVID-19.
Source:
JAMA Intern Med
2022
Aug
18; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Paul S. Mueller, MD, MPH, FACP